Cultural Diversity in counseling: challenges and opportunities

The U.S. population is becoming more culturally diverse each year, at a faster rate than previously forecasted by census data. Ahead of the nation’s 2020 census, it was estimated that almost four in ten Americans identified with a non-white ethnic group or race. Between 2000 and 2019, the white population decreased by 10%.¹ In the mental health counseling profession, cultural diversity plays a significant role. Whether it’s multicultural representation within the counseling industry or the increased attention on multicultural training to serve an increasingly diverse population more effectively, cultural diversity in counseling is a hot topic.

Multicultural counseling professionals with the right training and expertise are in high demand. Keep reading to learn about cultural diversity in counseling—how different ethnicities are represented in the field, key multicultural considerations in counseling policy and practice, and steps that are being taken to encourage cultural competence in therapy.

Despite increasing diversity in the U.S. and the higher rate at which people of color (POC) experience barriers to care and adverse mental health outcomes, mental health professionals are mostly white.² According to the American Psychological Association in 2015, just 15% of psychologists in the U.S. were POC.³ By 2019, this number hadn’t improved significantly. The Bureau of Labor Statistics reported that in the U.S., almost 70% of social workers and 76% of mental health counselors were white.⁴

Having a diverse staff of counselors doesn’t just pertain to race (although racial identity development can be very important in counseling). It also includes having counselors with backgrounds in different religions, different ages, those who are multilingual and can overcome language barriers in therapy, therapists who can provide LGBTQ+ counseling and pull from experience to help their clients. There are so many demographic and psychographic pieces to every person’s identity that can affect how and whether they seek out help. Having someone who feels familiar and shares your characteristics can be really comforting to clients.

This lack of representation makes the need for multicultural counseling competence even more urgent. Cultural identity affects how people view mental health, illness, and the world. This has far-reaching implications for mental health counselors and the counseling profession in general, whether it’s to understand how people of a certain culture seek treatment, how they view the client/therapist counseling relationship, or how they internalize and deal with discrimination issues. Counselors must be able to engage clients from diverse cultures in an equitable and sustainable manner.⁵

A key part of increasing diversity in counseling is to understand some of the factors that historically contributed to its homogenous makeup. In some cases, barriers to seeking out and receiving mental health treatment hinge on cultural differences or systemic issues that overwhelmingly impact minority groups.

It has been found in high-income countries (HICs), such as the U.S., Canada, and Australia, that individuals belonging to non-dominant cultures seek help later when facing mental distress, even when the situation is more acute. This may be related to a feeling of shame, as was found by research conducted with refugees and migrants in HICs and populations in lower-income countries in Asia. There may be a reluctance to share personal information with strangers or a desire to protect individual dignity and family reputation. For this reason, talk therapy may be less successful for these groups than other counseling modalities. ⁵

Willingness to seek treatment is also linked to the history of a person’s cultural group. For example, in HICs that have a colonial past, indigenous people are predisposed to mental health issues that can be linked to a history of oppression, dispossession, and intergenerational trauma. Due to histories of persecution and racism, people in Latino and African American communities may also distrust clinicians.⁵

A lack of understanding of cultural differences can cause healthcare practitioners to stereotype or misinterpret situations, which may lead to inappropriate or inadequate treatment.⁵ Counselors should be committed to expanding their cultural competency and understanding how diverse cultures cope with hardships can help to promote mental health and prevent illness.

In addition to cultural differences, there are often overarching systemic issues preventing people from getting the care they need. While most Americans are now insured, many insured patients often have difficulty navigating the American health system and finding providers within their specific insurance network, or could face high out-of-pocket prices and copays on appointments.⁶

Even if people are able to access care financially, it may take them a while to get an appointment. One study reports that more than one-third of Americans live in mental health professional shortage areas. These areas are defined by the U.S. government taking into account the ratio of mental health providers to those in need of care, the poverty rate, the proportion of the area that is either young or elderly, the prevalence of alcohol and substance abuse, and travel time to a mental health facility. It’s estimated that more than six thousand mental health providers would be needed to fill the gaps.⁷

Another shortage that affects all health care types is that of interpreters. While many health care systems will ensure that interpreters are available for all patients, a lack of interpreters continues to be a problem globally, and can prevent people from getting help or accurately conveying their problems to a health care worker.⁵

Imagine trying to explain your feelings after a breakup to someone who's never even gone on a date before. While this example simplifies the disconnect, it hints at the complications that come from seeking emotional support in a difficult situation from someone who perhaps doesn’t have a good understanding of your experience in the first place. A counselor who misgenders LGBTQ clients, or a therapist who doesn’t understand a client’s religious background might even end up causing more harm than good. If a patient feels invalidated by a provider, they could resist seeking help in the future.

“Multicultural/diversity competence”—also phrased as “cultural competence in therapy” or “multicultural counseling competence”—refers to a therapist’s awareness of cultural and diversity issues, that person’s understanding and knowledge of themselves and others, and how this is effectively applied in counseling practice. In 2014, The American Counseling Association (ACA) released its ACA Code of Ethics, which directs counselors to recognize and respect clients’ cultural differences when using assessment techniques and in supervisory roles. Counselor educators are advised to include multicultural and diversity training in their workshops and courses and to recruit a diverse student body.⁸

Within the past decade, professionals in the mental health field have acknowledged the need to incorporate cultural diversity in counseling to provide the best possible care for people with varied racial and ethnic backgrounds. There are many ways for counselors and counseling associations to expand the cultural diversity and competency of their practices. Counselors can:

• Explore and record their own values and beliefs to better see how they naturally relate to others
• Attend diversity-focused conferences to expand their knowledge and network
• Stay up-to-date on research through journals and magazines

• Learn about different cultures–especially if they know they’ll be treating a certain population that’s different from the counselor’s own background

There are many existing resources available for counselors eager to expand their cultural competency:

• The Substance Abuse and Mental Health Services Administration (SAMHSA) published the Improving Cultural Competence Quick Guide for Clinicians as part of its Treatment Improvement Protocol (TIP) series. This guide defines cultural competence, explains why it’s important and provides guidelines for working with culturally diverse individuals.⁹
• A 2019 ACA article on multicultural encounters in mental health counseling highlights the need for counseling professionals to expand their awareness and knowledge of multiculturalism and enhance their skills in order to serve an increasingly diverse population effectively.¹⁰
• The American Psychological Association (APA) created a multicultural training database with videos, curriculum and more to help you learn–and teach–cultural diversity.

Increasing the availability and the quality of multicultural counseling can improve the therapy experience, and hopefully the mental health, of all sorts of people. But this change can’t just come from therapists one-by-one. A push needs to come across the field starting with counselor educators and academic programs that advocate for cultural sensitivity in counseling. Counseling programs like the one at Marquette University are dedicated to exposing students to multicultural counseling from working with immigrant clients to providing racial identity development, teaching cross-cultural communication and underscoring the importance of cultural awareness within a community.

With an online Master of Science in Clinical Mental Health Counseling (CMHC) from Marquette University, you can pursue a fulfilling career as a counselor, serving culturally diverse clients. In as few as three years, you’ll be highly qualified to work in a wide range of settings, from hospitals and community health centers to prisons, residential mental health facilities or private practice. The CMHC program combines rigorous coursework taught by seasoned professionals with a practicum and internship in the field.

Take a deep dive into topics such as the foundations of clinical mental health counseling, multicultural training, professional ethics and legal issues, psychopathology and diagnosis, research methods, assessment, family and group counseling, and addictions.

To learn how the Marquette University online MS in Clinical Mental Health Counseling can help you begin or advance your career in counseling, contact an Admissions Advisor today.